[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4363 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 4363
To address the health of cancer survivors and unmet needs that
survivors face through the entire continuum of care from diagnosis
through active treatment and posttreatment, in order to improve
survivorship, treatment, transition to recovery and beyond, quality of
life and palliative care, and long-term health outcomes, including by
developing a minimum standard of care for cancer survivorship,
irrespective of the type of cancer, a survivor's background, or
forthcoming survivorship needs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 23, 2023
Ms. Wasserman Schultz (for herself, Mr. Fitzpatrick, Mr. DeSaulnier,
Mr. Carson, Mr. Mfume, Mr. Moskowitz, and Ms. Clarke of New York)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committees on Ways and
Means, and Education and the Workforce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To address the health of cancer survivors and unmet needs that
survivors face through the entire continuum of care from diagnosis
through active treatment and posttreatment, in order to improve
survivorship, treatment, transition to recovery and beyond, quality of
life and palliative care, and long-term health outcomes, including by
developing a minimum standard of care for cancer survivorship,
irrespective of the type of cancer, a survivor's background, or
forthcoming survivorship needs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Comprehensive
Cancer Survivorship Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Coverage of cancer care planning and coordination services.
Sec. 5. Survivorship transition tools.
Sec. 6. Alternative payment model.
Sec. 7. Survivorship navigation.
Sec. 8. Survivorship care demonstration program.
Sec. 9. Cancer survivor employment assistance program.
Sec. 10. Comprehensive cancer survivorship program.
Sec. 11. Adult cancer survivorship study.
Sec. 12. Survivorship progress report.
Sec. 13. Promoting State innovations to ease transitions to the primary
care setting for children with cancer.
Sec. 14. Childhood cancer demonstration model and standard of care.
Sec. 15. Medicaid coverage of cancer fertility services for cancer
survivors.
SEC. 2. FINDINGS.
Congress finds the following:
(1) A cancer survivor is any individual with a history of
cancer, from the time of diagnosis through the rest of their
life, across the continuum of care.
(2) Today, there are approximately 18,000,000 Americans who
are cancer survivors, and the number of survivors is projected
to reach 26,000,000 by 2040. Therefore, there is a great need
to be able to provide ways to sustain the care needed and to
offer those living with, through, and beyond cancer a safe,
supportive, and accommodating environment where such
individuals can engage in physical and social support
activities to sustain optimal quality of life.
(3) Cancer survivors face difficult emotional,
psychological, neurological, financial, legal, and other
physical challenges that persist beyond diagnosis and
treatment, often arising months and years after active cancer
treatment ends.
(4) Cancer survivors have unique needs and must manage
short- and long-term effects of their treatment, as well as
regular screenings for cancer recurrence or new cancers.
(5) Cancer survivors of racial and ethnic diversity, as
well as lower socioeconomic status, have disproportionately
lower health-related, quality-of-life scores compared to non-
Hispanic White cancer survivors.
(6) Cancer survivors living in rural areas have less access
to services and have poorer outcomes than survivors in
metropolitan areas.
(7) Children, adolescent, and young adult cancer survivors
are particularly susceptible to long-term consequences from
treatment, and up to 80 percent have a severe, disabling, life-
threatening, or fatal health condition by the age of 50. Best
practices in this area would improve treatment, quality of
life, and long-term health outcomes.
(8) Clinical trials have shown that cancer survivorship
programs help cancer survivors meet or exceed the recommended
amount of physical activity, significantly increasing their
cardiovascular health and overall quality of life and
decreasing their cancer-related fatigue.
(9) Despite the National Cancer Institute and other
professional organizations' definition of a cancer survivor
beginning on the day of a cancer diagnosis, there is little
agreement among clinicians, researchers, and insurance
companies on what services are included in ``survivorship
care'' and the point at which ``survivorship care'' begins.
(10) Cancer survivors, their families, their caregivers,
and their providers face many difficulties understanding and
coordinating the transition from specialty to primary care, and
for this reason communication and treatment are often
fragmented and inconsistent.
(11) To avoid additional health-related or financial
hardships to cancer survivors and their families, comprehensive
and forward-thinking cancer survivorship studies and programs
across Federal agencies, in collaboration with States,
localities, and medical and professional organizations, are
required to engage in a coordinated effort to improve health
outcomes and quality of life of survivors.
SEC. 3. DEFINITIONS.
In this Act:
(1) Cancer survivor.--The term ``cancer survivor'' means an
individual from the time of cancer diagnosis through the
balance of his or her life.
(2) Caregiver.--The term ``caregiver'' means a family
member, friend, or other person who cares for an individual
with a chronic or disabling condition, including cancer.
(3) Patient experience data.--The term ``patient experience
data'' means patient experiences, perspectives, needs, and
priorities related to--
(A) the symptoms of the patient's conditions and
the natural history of such conditions;
(B) the impact of the conditions on the patient's
functioning and quality of life;
(C) the patient's experience with treatments;
(D) input on which outcomes are important to the
patient;
(E) patient preferences for outcomes and
treatments; and
(F) the relative importance of any issues as
defined by patients.
(4) Psychosocial effects.--The term ``psychosocial
effects''--
(A) means the psychological, behavioral, emotional,
and social effects of a disease, such as cancer, and
its treatment; and
(B) in the case of such effects of cancer, includes
changes in how a patient thinks, their feelings, moods,
beliefs, ways of coping, and relationships with family,
friends, and coworkers.
(5) Psychosocial care.--The term ``psychosocial care''
means psychological and social services and interventions that
enable survivors, patients, their families, and health care
providers to optimize health care and to manage the
psychological, behavioral, physical, emotional, and social
aspects of illness and its consequences so as to promote better
health and well-being.
(6) Secretary.--Except as otherwise specified, the term
``Secretary'' means the Secretary of Health and Human Services.
(7) Survivorship.--The term ``survivorship'' means the
period from the time of cancer diagnosis until the end of life,
including any portions of such period during which
interventions are necessary to address--
(A) the physical, mental, emotional, social, and
financial effects of cancer that begin at diagnosis and
continue through treatment and beyond; and
(B) issues related to follow-up care (including
regular health and wellness checkups), late and long-
term effects of treatment, screening for cancer
recurrence and new cancers, and quality of life.
(8) Survivorship care plan.--The term ``survivorship care
plan''--
(A) means an individualized care plan for patients
who have been diagnosed with cancer; and
(B) includes a treatment summary and any follow-up
care guidelines in such plan that--
(i) are for monitoring and maintaining the
patient's medical and psychosocial health and
well-being; and
(ii) are meant to be a transition and
communication tool for the survivor, their
family, their caregiver, and all their health
care providers.
(9) Survivorship navigation.--The term ``survivorship
navigation'' means a service that--
(A) helps patients overcome health care system and
other barriers; and
(B) provides patients with timely access to high-
quality medical, physical, and psychosocial care from
their cancer diagnosis through all phases of their
cancer experience.
(10) Treatment summary.--The term ``treatment summary''
means a detailed summary of a patient's disease, the types of
treatment the patient received, members of the patient's care
team, and any side effects or other problems, including
psychosocial effects, caused by treatment.
SEC. 4. COVERAGE OF CANCER CARE PLANNING AND COORDINATION SERVICES.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended--
(1) in subsection (s)(2)--
(A) by striking ``and'' at the end of subparagraph
(II);
(B) by adding ``and'' at the end of subparagraph
(JJ); and
(C) by adding at the end the following new
subparagraph:
``(KK) cancer care planning and coordination services (as
defined in subsection (nnn));''; and
(2) by adding at the end the following new subsection:
``Cancer Care Planning and Coordination Services
``(nnn)(1) The term `cancer care planning and coordination
services' means, with respect to an individual who is diagnosed with
cancer, the development of a treatment plan by a physician, physician
assistant, or nurse practitioner that--
``(A) includes each component of the Institute of Medicine
Care Management Plan (as described in the article entitled
`Delivering High-Quality Cancer Care: Charting a New Course for
a System in Crisis' published by the Institute of Medicine);
``(B) is furnished in written form or electronically, at
the visit of such individual with such physician, physician
assistant, or nurse practitioner, or as soon after the date of
the visit as practicable; and
``(C) is furnished, to the greatest extent practicable, in
a form that appropriately takes into account cultural and
linguistic needs of the individual in order to make the plan
accessible to such individual.
``(2) The Secretary shall establish frequencies at which services
described in paragraph (1) may be furnished, provided that such
services may be furnished with respect to an individual--
``(A) at the time such individual is diagnosed with cancer
for purposes of planning treatment;
``(B) if there is a change in the condition of such
individual or such individual's treatment preferences;
``(C) at the end of active treatment and beginning of
survivorship care; and
``(D) if there is a recurrence of such cancer.''.
(b) Payment Under Physician Fee Schedule.--
(1) In general.--Section 1848(j)(3) of the Social Security
Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
``(2)(KK),'' after ``health risk assessment),''.
(2) Initial rates.--Unless the Secretary otherwise
provides, the payment rate specified under the physician fee
schedule under the amendment made by paragraph (1) for cancer
care planning and coordination services shall be the same
payment rate as provided for transitional care management
services (as defined in CPT code 99496).
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after the first day of the first
calendar year that begins after the date of the enactment of this Act.
SEC. 5. SURVIVORSHIP TRANSITION TOOLS.
(a) In General.--The head of the Office of the National Coordinator
for Health Information Technology, in collaboration with Director of
the Agency for Healthcare Research and Quality, shall--
(1) evaluate existing models for survivorship care plans,
as they relate to both adults and children, through engagement
with professional societies, payors, patient advocacy
organizations, community-based organizations, electronic health
record vendors, and other stakeholders;
(2) evaluate other existing tools for developing
survivorship care plans, such as--
(A) survivorship guidelines of the National
Comprehensive Cancer Network and the American Society
of Clinical Oncology; or
(B) tools such as Passport for Care;
(3) collaborate with the Office for Civil Rights of the
Department of Health and Human Services to evaluate the privacy
and security implications of--
(A) consolidating treatment history and
survivorship guidelines into a personalized
survivorship care plan, as described in paragraph (4);
and
(B) patient use of computer or mobile phone-based
application programs described in paragraph (4)(B); and
(4) taking into consideration the results of evaluation
under paragraphs (1) and (2)--
(A) not later than 36 months after the date of
enactment of this Act, publish information resources
for cancer patients and providers on strategies for
consolidating treatment history and survivorship
guidelines into a personalized survivorship care plan
to guide survivorship monitoring and follow-up care;
and
(B) include in such information resources
recommendations about possible patient use of
application programs (``apps'') to develop personalized
survivorship care plans.
(b) Definition.--In this section, the term ``electronic health
record'' means an electronic record of health-related information on an
individual that is created, gathered, managed, and consulted by
authorized health care clinicians and staff.
SEC. 6. ALTERNATIVE PAYMENT MODEL.
Not later than 18 months after the date of enactment of this Act,
the Secretary of Health and Human Services shall develop an alternative
payment model for payment under title XVIII and XIX of the Social
Security Act (42 U.S.C. 1395 et seq., 1396 et seq.) for items and
services relating to cancer survivorship care (as defined by the
Secretary). Following such testing, the Secretary shall submit to
Congress a report containing a description of such model that includes
the following information:
(1) A description of what event would trigger an
individual's entry into such a model (such as the end of the
individual's active cancer treatment, the beginning of the
individual's need for supportive care during active treatment,
or another event).
(2) The length of the individual's participation under such
model, including a description of any ability to extend such
participation.
(3) In the case that such model is based on an episode of
care, the appropriate length of the survivorship episode of
care and whether additional episodes may be triggered, if
necessary.
(4) Strategies to ensure that any episode of care under
such a model begins with the development and dissemination of a
survivorship care plan for the transition from active cancer
treatment to follow-up care to the individual and all relevant
health care providers.
(5) A description of any bundled payment packages that will
be used under such model.
(6) A specification of any follow-up or new screening under
such model for unmet needs of individuals participating in such
model.
(7) How consistent, shared decision making will be promoted
under such model so that individuals are given the knowledge
needed for self-management between episodes of care.
(8) A specification of which types of health care providers
may furnish items and services under such model, including
genetic counselors and mental health professionals.
(9) Strategies for applying evidence-based risk
stratification principles to direct survivors to personalized
care pathways that match the level of care needed to the
relative risks and needs of the survivor.
(10) Strategies for coordination of care between such
providers, such as between specialists and primary care
providers, and how principal responsibility will be assigned
for an episode of care.
(11) Strategies for addressing social determinants of
health through such model.
(12) A description of how such model will promote--
(A) prevention, early detection surveillance, and
treatment for individuals continuing to receive
systemic therapy after the end of active cancer
treatment;
(B) such individuals' understanding of, and access
to, treatment;
(C) survivorship research; and
(D) the continuing health of cancer survivors.
(13) An analysis of how different forms and stages of
cancer may require the development of different survivorship
plans and alternative payment models based on varying episodes
of care.
(14) A plan for testing any alternative payment model
described in the report, including the timing of such testing,
an analysis of the impact of such testing, any barriers to
implementing such testing, and any other recommendations
determined appropriate by the Secretary.
SEC. 7. SURVIVORSHIP NAVIGATION.
(a) Review of Programs and Navigation Study.--
(1) In general.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall--
(A) complete a review of previous and current
cancer survivorship navigation programs, including any
applicable standards of care such as those of the
Professional Oncology Navigation Task Force, and the
Academy of Oncology Nurse & Patient Navigators, the
Oncology Nursing Society; and
(B) submit a report to the Congress on the results
of such review.
(2) Considerations.--In carrying out subsection (a), the
Secretary shall take into consideration each of the following:
(A) How cancer survivorship navigation program
services might be provided from diagnosis across the
continuum of care through survivorship, taking into
consideration--
(i) the type of navigation services that
are most effective for survivors at the time of
diagnosis; and
(ii) the type of navigation services that
are most useful for survivors who are managing
the late and long-term effects of cancer and
cancer treatment.
(B) How navigation services might evolve over the
continuum of care and how to encourage a dynamic
navigation system.
(C) Training needs for navigators.
(D) Comparison and delineation of navigation
services provided by lay and professional navigators.
(E) Evaluation of optimal strategies for offering
survivors navigation services and encouraging their
utilization of such services.
(F) Defining--
(i) the continuum of care during which
services are provided; and
(ii) the nature of services for a long-term
survivor.
(G) The location of navigation services (such as
whether such services should be provided as part of
oncology practices or outside of oncology practices).
(H) Federal financing for navigation services (such
as whether to finance such services through a grant
program funded through annual discretionary
appropriations).
(I) Alternative delivery and payment models for
cancer survivorship navigation services, including
consideration of--
(i) an episode-of-care model for providing
cancer survivorship navigation services, or a
patient-focused navigation benefit that
survivors could utilize in different settings,
with the navigation services meeting standards
set by the Secretary; and
(ii) services funded through the Medicare
and Medicaid programs.
(J) Resources and the role of patient advocacy
organizations and peer support networks in cancer
survivorship navigation services.
(b) Demonstration Program for Navigation Services for Cancer
Survivors.--
(1) In general.--The Secretary shall carry out a
demonstration program consisting of awarding grants to eligible
entities to provide navigation services to cancer survivors.
(2) Timing.--The Secretary shall initiate the demonstration
program under this subsection not later than 12 months after
completing the review as required under subsection (a)(1)(A).
(3) Eligible entities.--To be eligible to receive a grant
under this subsection, an entity shall--
(A) have staff and expertise to provide navigation
services; and
(B) be--
(i) a community-based organization;
(ii) a patient-centered education and
service organization;
(iii) a nonprofit patient or cancer
advocacy organization;
(iv) a community cancer provider;
(v) a cancer center;
(vi) a hospital;
(vii) a community health center;
(viii) a rural health clinic; or
(ix) another type of entity as the
Secretary determines appropriate.
(4) Use of funds.--A recipient of a grant under this
section shall use the grant to provide navigation services to
cancer survivors, including by--
(A) offering navigation services from diagnosis
through the continuum of care, including long-term
survivorship, or offering navigation services from the
end of active treatment with an emphasis on
facilitating the transition from active treatment to
long-term survivorship care and throughout
survivorship;
(B) in a timely manner, assisting cancer survivors
to navigate cancer treatment and follow-up services,
such as screenings, risk assessment, mitigation, health
promotion activities, providing health information and
education, coaching, and support;
(C) addressing cancer care disparities in the
design and delivery of services;
(D) ensuring coordination with the survivor's
health care providers;
(E) following evidence-based survivorship care
guidelines in the design and delivery of survivorship
services;
(F) ensuring the delivery of culturally appropriate
services and materials; and
(G) assisting cancer survivors to meet and overcome
barriers to treatment and follow-up services, such as
any such barriers relating to food insecurity, housing,
transportation, labor, access to broadband
connectivity, the availability of telehealth, or child
care, with emphasis placed on high-risk populations.
SEC. 8. SURVIVORSHIP CARE DEMONSTRATION PROGRAM.
(a) In General.--The Secretary shall carry out a demonstration
program for a period of 5 years consisting of awarding grants to
improve the quality of cancer survivorship care.
(b) Timing.--The Secretary shall initiate the demonstration program
under this section not later than 1 year after the date of enactment of
this Act.
(c) Demonstration Sites.--The Secretary shall ensure that grants
are awarded under this section to improve the quality of cancer
survivorship care at a wide diversity of sites, including--
(1) in urban, suburban, rural, and Tribal areas;
(2) in one or more territories of the United States; and
(3) at cancer care sites including cancer centers, academic
health centers, Federally qualified health centers, rural
health clinics, physician offices, Tribal organizations,
community-based health care providers, and health care
providers serving medically underserved communities.
(d) Areas of Focus Under the Demonstration Program.--The
demonstration program under this section shall be designed to ensure
the development of a variety of models for survivorship care that will
permit evaluation of a variety of care strategies, including--
(1) utilization of navigators to assist survivors in
obtaining survivorship care;
(2) employment of risk-stratification to better determine
the nature and intensity of services that survivors require;
(3) transitions of care from cancer care providers to
primary care providers, through transition-of-care models that
involve collaboration between cancer care specialists and
primary care providers;
(4) the training needs of primary care providers to be
better equipped to work with survivors in primary care
settings;
(5) utilization of survivorship care plans to facilitate
coordination of survivorship care;
(6) experimentation with providing cancer survivorship care
at home;
(7) use of information technology to plan and coordinate
care to improve the consistent identification, collection, and
measurement of all forms of patient experience data, including
patient-reported outcomes of patient-reported symptoms and
quality-of-life measures; and
(8) expansion of existing successful models of survivorship
care.
(e) Evaluation of Demonstration Program.--The Secretary shall--
(1) develop a plan for evaluating the projects that are
conducted as part of the demonstration program under this
section; and
(2) not later than 18 months after the end of the 5-year
demonstration program, complete such evaluation and submit a
report to the Congress on the results of such evaluation.
(f) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $20,000,000 for each of fiscal
years 2024 through 2028.
SEC. 9. CANCER SURVIVOR EMPLOYMENT ASSISTANCE PROGRAM.
(a) In General.--The Secretary of Labor, in consultation with the
Secretary of Health and Human Services, shall carry out a program to
award grants to nonprofit organizations and other entities to provide
education and targeted assistance--
(1) to eligible cancer survivors facing barriers to
employment, including those who remain in the workforce during
treatment, those who reduce working hours while in treatment,
and those who reenter the workforce after a treatment-related
departure; and
(2) to the families and caregivers of such eligible cancer
survivors.
(b) Program Components.--The program under this section shall
include the following:
(1) Assistance, career and training services, and
supportive services for eligible cancer survivors who stay in
the workforce during treatment, and for their families and
caregivers, including--
(A) transportation assistance;
(B) childcare assistance;
(C) nutritional assistance;
(D) physical activity assistance;
(E) psychosocial assistance;
(F) financial assistance during a period of medical
leave; and
(G) other similar assistance.
(2) Assistance and education for eligible cancer survivors
who leave the workforce during treatment, and for their
families and caregivers, including--
(A) financial assistance during a period of medical
leave;
(B) assistance with premiums for continuation
coverage provided pursuant to part 6 of subtitle B of
title I of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1161 et seq.), title XXII of the
Public Health Service Act (42 U.S.C. 300bb-1 et seq.),
or section 4980B of the Internal Revenue Code of 1986
(26 U.S.C. 4980B); and
(C) career and training services, including
upskilling and reskilling, for eligible cancer
survivors who are not able to return to work after
treatment.
(3) Assistance, career and training services, and
supportive services for eligible cancer survivors who are
unable to work after a cancer diagnosis, and their families and
caregivers, including--
(A) assistance in applying for--
(i) supplemental security income benefits
under title XVI of the Social Security Act (42
U.S.C. 1381 et seq.);
(ii) disability insurance benefits under
section 223 of the Social Security Act (42
U.S.C. 423);
(iii) benefits under a State plan, or
waiver of such plan, under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.);
(iv) with respect to minimizing delays in
eligibility before a cancer survivor becomes
eligible for Medicare coverage, benefits under
the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1801 et seq.),
including with respect to enrolling in plans
under part C or D of such title and
supplemental plans under section 1882 of such
title;
(v) State and private sector assistance
programs for such cancer survivors; and
(vi) career and training services available
under title I, II, or IV of the Workforce
Innovation and Opportunity Act (29 U.S.C. 3101
et seq.); and
(B) information on the eligibility of a cancer
survivor, and their families and caregivers, for
benefits or services described in any of clauses (i)
through (vi) of subparagraph (A).
(c) Evidence-Based Resources.--In carrying out this section, the
Secretary of Labor, in consultation with the Secretary of Health and
Human Services, shall use evidence-based resources, including--
(1) nationally recognized evidence-based guidelines; and
(2) other resources as determined by the Secretary.
(d) Definitions.--In this section:
(1) The term ``eligible cancer survivor'' means a cancer
survivor (as defined in section 3) who--
(A) remains in the workforce during cancer
treatment;
(B) reduces working hours during cancer treatment;
(C) reenters the workforce after a cancer
treatment-related departure; or
(D) leaves the workforce as the result of a cancer
diagnosis or related complications.
(2) The term ``supportive services'' has the meaning given
such term in section 3 of the Workforce Innovation and
Opportunity Act (29 U.S.C. 3102).
SEC. 10. COMPREHENSIVE CANCER SURVIVORSHIP PROGRAM.
(a) In General.--The Secretary shall carry out a comprehensive
cancer survivorship program that includes--
(1) a cancer survivorship resource center in accordance
with subsection (b) to provide evidence-based resources to
cancer survivors, their families, and their caregivers;
(2) a health care professional resource center in
accordance with subsection (c) to assist and educate health
care professionals in the delivery of high-quality survivorship
care;
(3) an educational campaign in accordance with subsection
(d) to provide health care professionals with resources to
improve cancer survivorship care; and
(4) a program of supportive care services in accordance
with subsection (e) to improve the quality of life and long-
term survivorship of cancer survivors.
(b) Cancer Survivorship Resource Center.--
(1) Establishment.--The Secretary shall establish and
operate a survivorship resource center (in this subsection
referred to as the ``Center'') that serves as a comprehensive
source of information and resources related to survivorship.
(2) Timing.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall establish and begin
operation of the Center.
(3) Consultation.--In establishing and operating the
Center, the Secretary shall consult with cancer survivors,
patient organizations, health professionals, researchers,
health education organizations, oncology professional societies
and other medical societies, community-based organizations, and
science education organizations regarding--
(A) the information and resources that would assist
cancer survivors in managing the survivorship
experience and obtaining high-quality care across the
continuum of care;
(B) gaps in such information and resources that
need to be addressed to respond to the needs of cancer
survivors; and
(C) optimal strategies for ensuring that cancer
survivors have access to the Center, including
strategies that provide virtual options, online
resources, and marketing.
(4) Use of available evidence-based resources.--In
establishing and operating the Center, the Secretary shall,
with permission and attribution, rely on and utilize the
evidence-based materials and resources developed, collected,
and distributed by cancer organizations.
(c) Health Care Professional Resource Center.--
(1) In general.--The Secretary shall establish and operate
a health care professional resource center (in this subsection
referred to as the ``Center'') that serves as a comprehensive
source of information and resources to assist health care
professionals in the delivery of high-quality survivorship
care.
(2) Reference cancer survivorship guidelines.--In
establishing and operating the Center, the Secretary shall
reference cancer survivorship guidelines developed by cancer
care professional societies, patient organizations, research
foundations, and other health care professional societies in
the development of materials related to survivorship care.
(3) Support partnerships between cancer specialty societies
and primary care provider organizations.--In establishing and
operating the Center, the Secretary shall facilitate
collaboration between cancer care specialty societies and
primary care provider organizations in the development of
standards for survivorship care, including standards for
coordination of care and transitions of care from active
treatment to long-term survivorship care.
(d) Campaign To Educate Survivors and Health Care Professionals in
Survivorship Care.--
(1) In general.--The Secretary acting through the Director
of the Centers for Disease Control and Prevention (in this
subsection referred to as the ``Secretary'') shall--
(A) expand educational programs and services to--
(i) health care professionals; and
(ii) cancer survivors, their families, and
caregivers; and
(B) enhance the continuing medical education
resources on cancer survivorship that are available to
health care professionals.
(2) Expand collaboration with comprehensive cancer control
national partnership and other organizations for survivorship
education and support.--
(A) In general.--The Secretary shall expand
collaborations with organizations that are part of the
Comprehensive Cancer Control National Partnership and
other organizations to focus on increasing education
and awareness related to cancer survivorship through
materials, resources, and other methods as necessary.
(B) Collaborate with the organizations in the
national partnership and other organizations.--The
Secretary shall collaborate with the organizations that
are part of the Comprehensive Cancer Control National
Partnership and other organizations to inform cancer
survivors of survivorship monitoring and follow-up
standards, availability of survivorship care services,
and how to access these services.
(C) Reference the survivorship standards of care
developed and published by cancer organizations.--In
collaboration with organizations that support the
National Comprehensive Cancer Control Program, the
Secretary shall--
(i) develop and implement a plan to
distribute survivorship educational materials
to ensure that such materials are accessible to
all cancer survivors, their families and
caregivers, and health care professionals; and
(ii) reference in such plan the
survivorship standards of care developed and
published by such organizations.
(3) Continuing medical education.--
(A) Development of programs.--
(i) Grants and contracts.--The Secretary
shall carry out a program of awarding grants
and contracts to eligible entities to support
the development of continuing medical education
programs for survivorship care that utilize and
rely on the guidelines for survivorship care
developed and published by national
organizations.
(ii) Timing.--Not later than 12 months
after the date of enactment of this Act, the
Secretary shall initiate the program required
by clause (i).
(B) Grants for development of curriculum for
survivorship continuing medical education.--
(i) In general.--The Secretary shall award
grants to eligible entities for development of
diverse, equitable, and culturally appropriate
curricula for survivorship care curriculum for
medical care.
(ii) Scope of curriculum.--To receive a
grant under this section, an applicant shall
demonstrate its ability to develop survivorship
care curriculum for medical care, taking into
consideration services from the legal, social
work, public health, behavioral sciences,
genetic, epidemiology, and nursing fields.
(C) Eligible entities.--In this paragraph, the term
``eligible entity'' includes a medical professional
society, a patient organization, an academic
institution, a cancer center, and any other entity with
experience in continuing medical education for cancer
professionals.
(4) Public awareness campaign.--The Secretary, at an
appropriate time after the availability of patient survivorship
materials, professional survivorship materials, and continuing
medical education programs under this subsection, shall
initiate a linguistically and culturally appropriate public
awareness campaign that targets the organization's catchment
area to ensure that cancer survivors, their families and
caregivers, health care professionals, and the public are aware
of the scope of survivorship educational and informational
resources available from the Centers for Disease Control and
Prevention.
(e) Cancer Survivorship Quality-of-Life Program.--
(1) In general.--The Secretary acting through the Director
of the Centers for Disease Control and Prevention (in this
subsection referred to as the ``Secretary'') shall carry out a
program of awarding grants to eligible entities to provide
services to cancer survivors to enhance their quality of life
and improve their long-term survival rates. Not later than 18
months after the date of enactment of this Act, the Secretary
shall commence operating such program.
(2) Eligible entity defined.--In this subsection, the term
``eligible entity'' includes an entity that is--
(A) a State comprehensive cancer program;
(B) a National Cancer Institute-designated cancer
center or centers; or
(C) a community-based organization, including a
patient advocacy organization, that--
(i) has the capacity to reach cancer
survivors through local, State, or national
organizations; and
(ii) is focused on cancer survivors and
strategies for meeting their needs related to
their health and well-being.
(3) Use of funds.--A grant received under this subsection
shall be used to provide services to cancer survivors to
enhance their quality of life and improve their long-term
survival rates, such as by assisting survivors to--
(A) engage in moderate physical activity and other
health-promoting activities, including ceasing tobacco
use and increasing consumption of healthy foods;
(B) increase access to services to mitigate
anxiety, depression, and uncertainty;
(C) utilize community support services to fully
implement survivorship care plans;
(D) access nutrition education and counseling; and
(E) adhere to a schedule for, and access, screening
for recurrence of cancer or the occurrence of other
primary cancers.
(4) Standards for application from eligible entities.--To
seek a grant under this subsection, an eligible entity shall
submit an application, at such time as may be required by the
Secretary, that includes--
(A) an explanation of how the entity will--
(i) provide cancer survivors access to
cancer patient navigator services;
(ii) overcome barriers to care for
communities of color and multilingual
communities;
(iii) provide culturally competent care;
and
(iv) work with and support caregivers of
cancer survivors;
(B) a description of how the entity receives
referrals of cancer survivors from health care
professionals, including health care professionals
serving historically disadvantaged and underserved
communities;
(C) documentation of the curriculum that will be
used for providers in the program, including mechanisms
to update the staff on curriculum changes; and
(D) an agreement to provide the Secretary
semiannual reports on--
(i) the number of participants served;
(ii) quality-of-life measures for
participants; and
(iii) plans for fostering communication
between oncology and non-oncology providers
serving participants.
(5) Responsibilities of the secretary.--The Secretary
shall--
(A) conduct outreach to inform health care
professionals of the availability of programs and
activities funded under this subsection;
(B) analyze the data submitted by grantees under
this subsection to determine the number of cancer
survivors served and the impact of the program under
this subsection on their quality of life; and
(C) share best practices among all grantees under
this subsection.
SEC. 11. ADULT CANCER SURVIVORSHIP STUDY.
(a) In General.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall complete a landscape
analysis that--
(1) assesses the potential benefits of an adult version of
the Childhood Cancer Survivor Study;
(2) assesses the financial costs and other burdens
associated with an adult cancer survivor study;
(3) identifies sources of data on adult cancer survivors;
(4) identifies gaps in data on adult cancer survivors,
compared to data collected in the Childhood Cancer Survivor
Study; and
(5) identifies strategies to publish data on adult cancer
survivors derived from research that is conducted or supported
by the National Cancer Institute, in a manner that is
accessible to cancer survivors, health care professionals,
researchers, and the public.
(b) Report.--Not later than 6 months after the date of completion
of the landscape analysis under subsection (a), the Secretary shall
submit to the Congress a report on the results of such landscape
analysis.
SEC. 12. SURVIVORSHIP PROGRESS REPORT.
(a) In General.--Not later than 6 months after the date of
enactment of this Act, the Secretary shall enter into an agreement with
the Government Accountability Office to conduct a study of the progress
made in cancer survivorship over the period beginning on the date of
enactment of the National Cancer Act of 1971 (Public Law 92-216).
(b) Scope of the Study.--The study under subsection (a) shall
investigate developments over the period described in subsection (a)
in--
(1) the nature and quality of survivorship care;
(2) transitions from active treatment to survivorship care;
(3) the quality of life of cancer survivors;
(4) outcomes for cancer survivors;
(5) disparities in access to care and survivorship
outcomes;
(6) the health care systems for providing survivorship
care;
(7) the contribution of community-based services to the
survivorship care system; and
(8) payment for survivorship care by public and private
third-party payors.
(c) Role of Office of Cancer Survivorship.--The study under
subsection (a) shall--
(1) consider the contribution of the Office of Cancer
Survivorship to the evolution of cancer survivorship care over
the last 25 years; and
(2) assess the impact of the mission of the Office and the
resources provided to the Office on its leadership in cancer
survivorship care.
(d) Public Meeting.--In conducting the study under subsection (a),
the Comptroller General of the United States shall hold a public
meeting with a broad cross section of stakeholders to inform the
study's findings and conclusions. Such stakeholders shall include--
(1) cancer survivors and their caregivers and families;
(2) patient organizations representing cancer survivors;
(3) oncologists involved in survivorship care and the
professional societies representing them;
(4) primary care providers involved in survivorship care
and the professional societies representing them;
(5) other health professionals providing survivorship care
and the professional societies representing them;
(6) community-based organizations involved in survivorship
care;
(7) representatives of the National Cancer Institute;
(8) third-party payors;
(9) researchers engaged in survivorship research;
(10) epidemiologists with knowledge of trends in cancer
survivorship; and
(11) such other stakeholders as the Comptroller General
deems important to participate in the public meeting.
(e) Report.--The Comptroller General of the United States shall--
(1) release a report on the results of the study under
subsection (a); and
(2) in addition to the public meeting convened under
subsection (d)--
(A) convene another public meeting to be held on
the day of the release of the report; and
(B) include in such meeting all categories of
stakeholders listed in subsection (d).
SEC. 13. PROMOTING STATE INNOVATIONS TO EASE TRANSITIONS TO THE PRIMARY
CARE SETTING FOR CHILDREN WITH CANCER.
(a) Stakeholder Group Development of Best Practices; State Medicaid
and CHIP Program Innovation.--
(1) Stakeholder group best practices.--Not later than 12
months after the date of the enactment of this Act, the
Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall convene a stakeholder
group of representatives of childhood cancer advocacy
organizations, Medicaid and CHIP beneficiaries, providers with
childhood cancer pediatric expertise, the National Association
of Medicaid Directors, and other relevant representatives to
develop best practices (and submit to the Secretary and
Congress a report on such best practices) for States to ease
the transition from active oncological care to primary care of
children or adolescents with cancer, including best practices
for ensuring development of and delivery of summary of care and
survivorship care plans to patients, families, and primary care
providers, and best practices for such transitions occurring
under the State Medicaid plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) or State child health
plan under title XXI of such Act (42 U.S.C. 1397aa et seq.), as
applicable. Such best practices shall include--
(A) design of models of follow-up care, monitoring,
and other survivorship programs (including peer support
and mentoring programs);
(B) development of models for providing
multidisciplinary care;
(C) dissemination of information to health care
providers about culturally and linguistically
appropriate follow-up care for cancer survivors and
their families, as appropriate and practicable; and
(D) dissemination of the information and programs
described in clauses (i) through (iii) to other health
care providers (including primary care physicians and
internists) and to cancer survivors and their families,
where appropriate and in accordance with Federal and
State law.
(2) State medicaid and chip program innovation.--The
Secretary shall work with States on innovative strategies,
based on the best practices identified under the process
described in subsection (a)(1), to ease the transition from
active oncological care to primary care of child or adolescent
with cancer ensuring development of and delivery of
survivorship care plans to patients, families, and primary care
providers and transition coverage under the State Medicaid plan
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) or State child health plan under title XXI of such Act
(42 U.S.C. 1397aa et seq.), as applicable.
(3) Nonapplication of federal advisory committee act.--The
Federal Advisory Committee Act (5 U.S.C. App.) shall not apply
to the stakeholder group convened under paragraph (1).
(b) Guidance on Innovative Service Delivery Systems Demonstration
Project Opportunities.--Not later than 1 year after the date the
stakeholder group is convened under subsection (a), the Secretary of
Health and Human Services shall issue guidance to State health
officials, based on best practices developed under subsection (a)(1),
regarding opportunities to improve care transitions for children and
adolescents with cancer who transition from oncological care to primary
care and who are otherwise eligible to receive medical assistance under
title XIX of such Act (42 U.S.C. 1396 et seq.) or title XXI of such Act
(42 U.S.C. 1397aa et seq.).
SEC. 14. CHILDHOOD CANCER DEMONSTRATION MODEL AND STANDARD OF CARE.
Section 1115A(b)(2) of the Social Security Act (42 U.S.C.
1315a(b)(2)) is amended--
(1) in subparagraph (A), by striking the period at the end
and inserting ``, and shall include the model described in
clause (xxviii) of such subparagraph.''; and
(2) in subparagraph (B), by adding at the end the following
new clause:
``(xxviii) A local service delivery and
State payment model for individuals up to age
21 enrolled under a State plan (or waiver of
such plan) under title XIX or a State child
health plan (or waiver of such plan) under
title XXI of such Act (42 U.S.C. 1397aa et
seq.) who have been diagnosed with cancer and
who are in the survivorship phase of their
treatment. Such model shall--
``(I) provide for the creation of a
survivorship plan, that can be
integrated into an electronic health
record, for such individuals and
disseminate the plan to such
individuals, families of such
individuals, and the health providers
of such individuals;
``(II) offer States and local
providers technical assistance to
develop and implement different
survivorship care planning services;
``(III) develop a standard of care
based on the Children's Oncology Group
(COG) Long-Term Follow-Up Guidelines
for Survivors of Childhood, Adolescent,
and Young Adult Cancers to manage the
transition of such individuals from
active treatment to general care with
the informed knowledge of such
individuals; and
``(IV) provide incentives to health
care providers for treating such
individuals through such model that
includes at least two survivorship care
planning visits.''.
SEC. 15. MEDICAID COVERAGE OF CANCER FERTILITY SERVICES FOR CANCER
SURVIVORS.
(a) Medicaid.--
(1) Mandatory coverage.--Section 1902(a)(10) of the Social
Security Act (42 U.S.C. 1396a) is amended--
(A) in subparagraph (F), by striking ``; and'' and
inserting a semicolon;
(B) in subparagrah (G), by adding at the end
``and''; and
(C) by inserting after subparagraph (G) the
following new subparagraph:
``(H) notwithstanding section 1902(a)(10)(B)
(relating to comparability), for making medical
assistance available for cancer fertility services (as
defined in subsection (jj));''; and
(2) Definition.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended by adding at the end the following
new subsection:
``(jj) Cancer Fertility Services.--
``(1) Definition.--For purposes of section 1902(a)(10)(H)
and this subsection, the term `cancer fertility services'--
``(A) means fertility treatment and fertility
preservation services for individuals diagnosed with
cancer who--
``(i) are undergoing treatment for such
cancer where such treatment may lead to
iatrogenic infertility;
``(ii) previously underwent such treatment
and may be at risk of such infertility due to
such treatment; or
``(iii) are preparing to undergo such
treatment where such treatment may lead to such
infertility; and
``(B) includes--
``(i) other services, including
experimental and non-experimental services to
preserve fertility or treat infertility (as
determined by the Secretary, consistent with
established medical practices and professional
guidelines published by the American Society
for Reproductive Medicine, the American Society
of Clinical Oncology, or other professional
medical organizations specified by the
Secretary); and
``(ii) long-term storage costs--
``(I) with respect to individuals
under the age of 18, for a period of
not less than 15 years; and
``(II) with respect to individuals
age 18 or older, for a period of not
less than 10 years.
``(2) Exception for territories.--Notwithstanding any other
provision of this title, in the case of a State (other than the
50 States and the District of Columbia), the requirement stated
in section 1902(a)(10)(H) shall be optional.''.
(3) Prohibition on cost-sharing.--
(A) In general.--Section 1916 of the Social
Security Act (42 U.S.C. 1396o) is amended--
(i) in subsection (a)(2)--
(I) in subparagraph (I), by
striking at the end ``, or'' and
inserting a semicolon;
(II) in subparagraph (J), by
striking at the end ``; and'' and
inserting ``; or''; and
(III) by adding at the end the
following new subparagraph:
``(K) cancer fertility services (as defined in
section 1905(jj)); and''; and
(ii) in subsection (b)(2)--
(I) in subparagraph (I), by
striking at the end ``, or'' and
inserting a semicolon;
(II) in subparagraph (J), by
striking at the end ``; and'' and
inserting ``; or''; and
(III) by adding at the end the
following new subparagraph:
``(K) cancer fertility services (as defined in
section 1905(jj)); and''.
(B) Application to alternative cost-sharing.--
Section 1916A(b)(3)(B) of the Social Security Act (42
U.S.C. 1396o-1(b)(3)(B)) is amended by adding at the
end the following new clause:
``(xv) Cancer fertility services (as
defined in section 1905(jj)).''.
(b) CHIP.--
(1) In general.--Section 2103(c) of the Social Security Act
(42 U.S.C. 1397cc(c)) is amended--
(A) by redesignating the paragraph (12) added by
section 11405(b)(1) of Public Law 117-169 as paragraph
(13); and
(B) by inserting after paragraph (11) the following
new paragraph:
``(12) Required coverage of cancer fertility services for
cancer survivors.--Regardless of the type of coverage elected
by a State under subsection (a), the child health assistance
provided for a targeted low-income child, and, in the case of a
State that elects to provide pregnancy-related assistance
pursuant to section 2112, the pregnancy-related assistance
provided for a targeted low-income pregnant woman (as such
terms are defined for purposes of such section), shall include
coverage of cancer fertility services (as described in section
1905(jj)).''.
(2) Prohibition on cost-sharing.--Section 2103(e)(2) of the
Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended--
(A) in the heading, by inserting ``cancer fertility
services,'' after ``covid-19 treatment,''; and
(B) by inserting ``cancer fertility services (as
described in section 1905(jj)),'' after ``testing or
treatments described in section 1916(a)(2)(I) furnished
during the period described in such section,''.
(3) Effective date.--The amendment made by paragraph (1)(A)
shall take effect on October 1, 2023.
(c) Effective Date.--The amendments made by this section (other
than the amendment made by subsection (b)(1)(A)) shall apply with
respect to medical assistance, child health assistance, and pregnancy-
related assistance furnished on or after the date that is 18 months
after the date of the enactment of this Act.
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